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Remote ischemic preconditioning reduces the incidence of contrast‐induced nephropathy in patients undergoing coronary angiography/intervention: Systematic review and meta‐analysis of randomized controlled trials
Author(s) -
Pranata Raymond,
Tondas Alexander E.,
Vania Rachel,
Toruan Mangiring P. L.,
Lukito Antonia A.,
Siswanto Bambang B.
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28709
Subject(s) - medicine , conventional pci , contrast induced nephropathy , percutaneous coronary intervention , subgroup analysis , randomized controlled trial , ischemic preconditioning , cardiology , nephropathy , incidence (geometry) , meta analysis , myocardial infarction , ischemia , physics , optics , diabetes mellitus , endocrinology
Background Contrast‐induced nephropathy (CIN) is associated with increased mortality and morbidity in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). We aimed to assess the latest evidence on the effect of remote ischemic preconditioning (RIPC) on the incidence of CIN in patients undergoing CAG/PCI. Methods We performed a comprehensive search on topics assessing RIPC and CIN in CAG/PCI patients from inception up until July 2019 through several electronic databases. Results There were a total of 1,925 subjects from 14 randomized controlled trials. Remote ischemic preconditioning was associated with reduced CIN incidence in patients undergoing CAG/PCI (OR 0.41 [0.30, 0.55], p < .001; I 2 : 22%). The nephroprotective effect was also demonstrated in those at moderate‐high risk for CIN subgroup (OR 0.41 [0.29, 0.58], p < .001; I 2 : 26%) and PCI‐only subgroup (OR 0.41 [0.29, 0.58], p < .001; I 2 : 0%). Time from RIPC to CAG/PCI has similar effectiveness among ≤45, ≤60, and ≤120 min. Mortality, rehospitalization, hemodialysis, and major adverse events were lower in the RIPC group (OR 0.50 [0.33, 0.76], p = .001; I 2 : 0%). Grading of recommendations assessment, development and evaluation (GRADE) assessment showed that RIPC has high evidence certainty for reducing CIN in patients undergoing PCI/CAG, moderate‐high risk subgroup, and PCI‐only subgroup with absolute reduction of 97 per 1,000, 129 per 1,000, and 121 per 1,000, respectively. Harbord test showed no evidence for the presence of small‐study effects ( p = .157). Conclusions Remote ischemic preconditioning is an effective procedure to reduce the risk of CIN and should be considered in patients with moderate‐high risk at developing CIN.